title: Endoscopic ultrasound-guided transmural drainage of postoperative pancreatic collections.
abstract: BACKGROUND
  Pancreatic leak is a major cause of morbidity after pancreatectomy. Traditionally, peripancreatic fluid collections have been managed by percutaneous or operative drainage. Data for endoscopic ultrasound (EUS)-guided drainage of postoperative fluid collections are limited. Here we report on the safety, efficacy, and timing of EUS-guided drainage of postoperative peripancreatic collections.
  
  
  METHODS
  This is a retrospective review of 31 patients who underwent EUS-guided drainage of fluid collections after pancreatic resection. Technical success was defined as successful transgastric deployment of at least one double pigtail plastic stent. Clinical success was defined as resolution of the fluid collection on follow-up CT scan and resolution of symptoms. Early drainage was defined as initial transmural stent placement within 30 days after surgery.
  
  
  RESULTS
  Endoscopic ultrasound-guided drainage was performed effectively with a technical success rate of 100%. Clinical success was achieved in 29 of 31 patients (93%). Nineteen of the 29 patients (65%) had complete resolution of their symptoms and collection with the first endoscopic procedure. Repeat drainage procedures, including some with necrosectomy, were required in the remaining 10 patients, with eventual resolution of collection and symptoms. Two patients who did not achieve durable clinical success required percutaneous drainage by interventional radiology. Seventeen (55%) of 31 patients had successful early drainage completed within 30 days of their operation.
  
  
  CONCLUSIONS
  Endoscopic ultrasound-guided drainage of fluid collections after pancreatic resection is safe and effective. Early drainage (<30 days) of postoperative pancreatic fluid collections was not associated with increased complications in this series.
authors.affiliation: Gastroenterology and Nutrition Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY.
authors.forename: Amy
authors.initials: A
authors.lastname: Tilara
authors.affiliation: Gastroenterology and Nutrition Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY.
authors.forename: Hans
authors.initials: H
authors.lastname: Gerdes
authors.affiliation: Hepatopancreatobiliary Surgery Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY.
authors.forename: Peter
authors.initials: P
authors.lastname: Allen
authors.affiliation: Hepatopancreatobiliary Surgery Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY.
authors.forename: William
authors.initials: W
authors.lastname: Jarnagin
authors.affiliation: Hepatopancreatobiliary Surgery Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY.
authors.forename: Peter
authors.initials: P
authors.lastname: Kingham
authors.affiliation: Hepatopancreatobiliary Surgery Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY.
authors.forename: Yuman
authors.initials: Y
authors.lastname: Fong
authors.affiliation: Hepatopancreatobiliary Surgery Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY.
authors.forename: Ronald
authors.initials: R
authors.lastname: DeMatteo
authors.affiliation: Hepatopancreatobiliary Surgery Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY.
authors.forename: Michael
authors.initials: M
authors.lastname: D'Angelica
authors.affiliation: Gastroenterology and Nutrition Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY. Electronic address: schattnm@mskcc.org.
authors.forename: Mark
authors.initials: M
authors.lastname: Schattner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001201:Ascites / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D004322:Drainage / Q000295:instrumentation / Q000379:methods*; D016145:Endoscopy, Digestive System / Q000379:methods*; D019160:Endosonography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000628:therapy*; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods*